Survival of cancer patients is greatly enhanced when the cancer is treated early. In the case of bladder cancer, patients diagnosed with disease that is confined to the primary site have a 5 year survival rate of 73%, compared to 6% for patients with metastatic disease (Altekruse et al). Therefore, developments that lead to early and accurate diagnosis of bladder cancer can lead to an improved prognosis for the patients. To aid in early detection of cancer a number of cancer specific markers have been identified. However the use of these markers can result in false positive results in patients having inflammatory bladder diseases, and not bladder cancer.
Asymptomatic hematuria (“AH”) is one of the most frequent urological findings, with incidence rates of between 2% and 30% depending on the population (Schwartz G: Proper evaluation of asymptomatic microscopic hematuria in the era of evidence-based medicine-progress is being made. Mayo Clin Proc. 2013, 88(2); 123-125, McDonald M, Swagerty D, Wetzel L: Assessment of Microscopic hematuria in adults. AFP 2006 73:10, Grossfield G, Wolf J, Litwan M, Hricak H, Shuler C, Agerter D, et al. Asymptomatic microscopic hematuria in adults: summary of AUA best practice policy recommendations. AFP 2001:63:1145-54).
AH is, however, indicative of broad range of pathologies with urinary tract malignancy incidences in the AH population ranging from 1.9-7%. Full diagnostic work up on all confirmed AH patients puts a considerable burden on many healthcare systems. Use of phenotypic indicators to segregate high and low risk patients has been explored in a recent study by Loo et al. (Loo R, Lieberman S, Slezak J, Landa H, Mariani A, Nicolaisen G, Aspera A and Jaconsen S: Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria. Mayo Clin Proc. 2013, 88(2); 129-138).
The above-mentioned study of 4414 patients presenting with confirmed AH showed that 73% of patients had no cause identified, while 26% of patients warranted some form of urological work up to identify the cause. Approximately 2.5% of patients presenting with AH were diagnosed with urothelial malignancy, with other conditions such as urinary tract infection (UTI) (2.3%), kidney stones (16.2%), prostatic bleeding (4%), and contamination (0.4%) making up the alternative diagnoses (Loo et al., Id.).